Provider Demographics
NPI:1285788604
Name:HOLLIDAY, KIMBERLY JACOBSEN (DMD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JACOBSEN
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:JACOBSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:341 AMSTAR ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8270
Mailing Address - Country:US
Mailing Address - Phone:803-732-0016
Mailing Address - Fax:
Practice Address - Street 1:384 ST ANDREWS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4427
Practice Address - Country:US
Practice Address - Phone:803-772-9994
Practice Address - Fax:803-772-7736
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice